Opinion
In this case of first impression, we are asked to determine the constitutionality of section 2292 of the Business and Professions Code, 1 authorizing the Board of Medical Quality Assurance 2 to compel a physician to undergo a professional competency examination. Respondent board, without first granting appellant John Phillip Smith, M.D., the right to appear at its hearing, ordered him to undergo this examination. On appeal, Smith contends, inter alia, that the board’s procedure denied him *320 equal protection and due process. We reject these contеntions and affirm the trial court’s judgment.
I. Facts
Appellant John Phillip Smith is a physician licensed to practice in this state. In May 1986, the executive director of the respondent Board of Medical Quality Assurance (the Board) prepared a petition requesting that Smith be compelled to take a professional competency examination. The petition alleged reasonable cause to believe that Smith was “unable to practice medicine with reasonable skill and safety to patients” and set forth, as a factual basis for this claim, five case histories of cardiac patients whom Smith was alleged to have improperly treated. Two cardiologists reviewed these case histories and concurred in the director’s recommendation.
Smith filed a timely written response to this petition and requested a hearing on the allegations. However, the Board approved the petition without granting Smith’s request and ordered him to undergo an examination. After reconsideration, an identical order was issuеd, also without first allowing Smith to appear at the hearing.
In January 1987, Smith filed a complaint, seeking declaratory and injunctive relief, a writ of mandate, and attorney fees. The trial court found that to be compelled to undergo an examination was not an infringement of such a significant liberty as to require the panoply of due process rights. Finding that Smith’s constitutional rights would be adequately protected if he failed the competency examination, the trial court denied the requested relief and entered judgment for the Board.
II. Reasonable Cause Proceeding A. Statutory Procedure
To understand Smith’s contentions on appeal, we first review the statutory scheme. Operative since 1985 (Stats. 1983, ch. 398, §§ 3, 6, pp. 1662-1663), section 2292 allows the Board to order a physician to undergo a professional competency examination if there is reasonable cause to believe that the physician is unable to practice medicine with reasonable skill and safety to patients. Reasonable cause is defined as a single act of gross negligence, a pattern of inaрpropriate prescribing, an act of incompetence or negligence causing death or serious bodily injury, or a pattern of substandard care. (§ 2292, subd. (a); see also §§ 820-824.)
Before a physician may be compelled to undergo an examination, a statutorily ordained procedure must be followed. First, the Board’s medical *321 consultant conducts an investigation and review, and concludes that reasonable cause exists to believe that the physician is unable to practice medicine with rеasonable skill and safety to patients. At least one outside medical consultant must review the matter and concur in this conclusion. (§ 2292, subd. (a).) Next, the Board’s executive director prepares a written petition detailing the reasonable cause and all conclusions and facts on which this presumption is based. A copy of the petition is served on the physician, who may file written opposition to it. (§ 2292, subd. (b); see Gov. Code, § 11505, subd. (c).) The Board’s Division of Medical Quality may consider the petition or may assign it to a mеdical quality review committee for consideration. (§ 2292, subd. (c); see § 2323.) This body must review the petition and opposition, and may conduct a hearing to determine if reasonable cause exists. (§ 2292, subd. (d); see Gov. Code, §§ 11500-11528.) If this body finds that reasonable cause exists, it must order the physician to undergo a professional competency examination. (§ 2292, subd. (d).) At the oral clinical examination, two physicians test the examinee on general medical knowledge and any special knowledge of one in the examinee’s type of practice. (§ 2293, subd. (a).)
If the physician passes the examination, an accusation of incompetency may not be filed if based solely on the circumstances giving rise to reasonable cause for the examination. (§ 2294, subd. (a).) In this circumstance, all agency records of the proceedings must be kept confidential and are not subject to discovery or subpoena. (§ 2294, subd. (b).) If no further proceedings have been conducted to determine the physician’s fitness to practice five years after the date of the petition, the agency must purge and destroy all records of the proceedings. (§ 2294, subd. (c).)
If both examiners agree that the physician failed the professional competency examination, a second examination is ordered before two other physicians. (§ 2293, subd. (b).) If the examinee fails the second examination, an accusation of incompetence may be filed against the physician. (§ 2293, subd. (c); see §§ 2230, 2234, subd. (d).) 3 Incompetence is a form of unprofessional conduct which, if prоven, may result in the revocation of a physician’s license. (§ 2234, subd. (d); see § 2227, subd. (a).) 4
A physician who fails to comply with the Board’s order to undergo the examination is guilty of unprofessional conduct. (§ 2292, subd. (d).) Under
*322
these circumstances, an accusation of unprofessional conduct
must
be filed against the physician. (§§ 2234, 2292, subd. (d).) This accusation subjects the physician to discipline and places his or her license to practice medicine in jeopardy. (See § 2227, subds. (a), (b); see also
Wood
v.
Superior Court
(1985)
B. Investigation or Accusation?
The nature of the Board’s reasonable cause proceeding is the one overriding issue on appeal. Is this an investigative proceeding or is it the equivalent of an accusation—the formal charge that must be brought before a physiciаn’s license to practice medicine may be revoked? (See §§ 2227, subd. (a), 2230; see also
Wood
v.
Superior Court, supra,
We believe that the reasonable cause proceeding is investigative rather than adjudicative. Procedural due process rights need not be conferred on those appearing before “purely investigative agencies” such as the federal Commission on Civil Rights.
(Hannah
v.
Larche
(1960)
The Board’s authority is somewhat different from that of the Commission on Civil Rights. As illustrated by this case, the Board has statutory authority to issue orders—to compel a physician to undergo a professional compe
*323
tency examination. Does this authority transform the Board’s proceedings into an adjudication? (See
Hannah
v.
Larche, supra,
363 U.S. at pp. 440-441 [4 L.Ed.2d at. pp. 1320-1321];
Stanson
v.
San Diego Coast Regional Com.
(1980)
In like manner, the fact that repeated failure of the required examination constitutes evidence of incompetence which may lead to revocation of his license does not transform the Board’s reasonable cause proceeding into an adjudicative matter. In
Hannah
v.
Larche, supra,
*324
Our conclusion that the Board’s function pursuant to section 2292 is investigatory rather than adjudicative is bolstered by the statute’s legislative intent. (See
Curtis
v.
County of Los Angeles
(1985)
Having reviewed the statute and its investigatory purpose, we now turn to Smith’s two constitutional claims—that section 2292 violates equal protection and due process under both the federal and state Constitutions.
III. Equal Protection
To be consistent with equal protection, persons similarly situated with respect to the legitimate purpose of a law are entitled to receive like treatment.
(People
ex rel.
Younger
v.
County of El Dorado
(1971)
“The first prerequisite to a meritorious claim under the equal protection clause is a showing that the state has adopted a classification that affects two or more
similarly situated
groups in an unequal manner.”
(In re
*325
Eric J.
(1979)
Smith also appears to challenge this statute as “standardless” because it does not set forth the criteria to be used to determine who receives a hearing and who does not. Although section 2292 does not expressly state it, the wording of the statute implies the Board has discretion to conduct a formal hearing if the Board determines that this would assist it in its reasonable cause determination. This discretion may not be exercised in an arbitrary fashion without exposing the Board to a judicial challenge for abuse of its discretion. (See
Bailey
v.
Taaffe
(1866)
We are satisfied that the Board did not abuse its discretion. The petition and opposition filed in this case clearly establish reasonable cause. The petition sets out five separate case histories of patients Smith is alleged to hаve improperly treated. The detailed histories fill all but three pages of the 16-page petition. The case histories demonstrate that Smith’s decisions about when to subject patients to invasive procedures were questionable, at best. Two lengthy letters from outside medical consultants concurring with the conclusions of the Board’s medical consultant are attached to the petition. The bulk of Smith’s opposition takes the form of a general denial, an assertion that he is presently able to practice medicine with reasonable skill and safety to patients, and a number of procedural objections. His only specific, substantive challenge to the petition is the initial opinion of a medical consultant that Smith’s conduct did not constitute malpractice. Even this minimal support for Smith’s position is undermined by an admission from this would-be consultant that he may not be the best-qualified person to serve as consultant in this matter. The only other documents filed with Smith’s opposition were 12 rather general letters of recommendation. The opposition papers did not raise any serious substantive challenge to the accuracy of the petition’s allegations.
IV. Procedural Due Process
Procedural due process requires notice, confrontation, and a full hearing whenever state action significantly impairs an individual’s freedom to pursue a private occupation.
(Endler
v.
Schutzbank
(1968)
A. Federal Constitutional Analysis
Under federal constitutional analysis, Smith must first establish that the due process clause applies by showing a protected liberty or property interest.
(Morrissey
v.
Brewer
(1972)
First, he contends that the Board’s action deprived him of the property interest represented by his license to practice medicine. Unquestionably, a physician has a vеsted property right in his or her medical license, once acquired. (See
Berlinghieri
v.
Department of Motor Vehicles
(1983)
Second, Smith claims that he has a liberty interest at stake—the right to be free not to spend his time preparing for a professional competency examination. As Smith points out, courts have not defined the concept of liberty with exactness. The Unitеd States Supreme Court has indicated that “liberty” is “ ‘not merely freedom from bodily restraint but also the right of the individual to contract, to engage in any of the common occupations of life, to acquire useful knowledge, to marry, establish a home and bring up children, to worship God according to the dictates of [one’s] own conscience, and generally to enjoy those privileges long recognized ... as essential to the orderly pursuit of happiness by free [people].’ ”
(Board of Regents
v.
Roth
(1972)
B. State Constitutional Analysis
State due process analysis differs from that conducted pursuant to the federal due process clause. Under our state Constitution, Smith need not establish a property or liberty interest as a prerequisite to invoking due process protection. (See
Schultz
v.
Regents of University of California
(1984)
The first factor is the private interest that will be affected by the official action. Smith claims two interests at stake—his right to practice medicine and his right to be free from the need to prepare for the Board-ordered professional competency examination. As we have previously discussed, Smith’s license to practice medicine is not impaired by this investigatory proceeding. (See part IV-A, ante.) However, the fact that the Board’s order may lead ultimately to license revocation, if Smith refuses to take the examination or twice fails it, constitutes an interest affected by the official action, however attenuated.
*328 The risk of erroneous deprivation of these interests because the Board failed to grant a formal hearing is remote. If a physician loses his or her license after the Board orders an examination to be conducted, that revocation would be the result of the physician’s demonstrated incompetencе or his or her refusal to comply with the Board’s order—not from the lack of an opportunity to address the Board at the reasonable cause hearing. The procedural safeguards that the statutory scheme requires later in the process are sufficient to protect physicians without imposing additional requirements at this investigatory stage.
The next factor is the individual’s interest in being informed of the nature, grounds, and consequences of official action and in enabling such persons to present their side of the story before a responsible government official. The statutory scheme requires the Board to provide notice of the petition, and requires the petition to set forth the facts and circumstances that led to the suspicion of reasonable cause. (§ 2292, subd. (b).)
Finally, we must weigh the government’s interest in the proceeding, including the function involved and the fiscal and administrative burdens that the additional or substitute procedural requirement would entail. The legislative history of section 2292 makes it clear that this statute wаs intended to provide the Board with an investigative tool, not a disciplinary one. (See part II-B,
ante.)
The United States Supreme Court has held that due process varies according to specific factual contexts. When government agencies adjudicate or make binding decisions that directly affect the legal rights of individuals, those agencies must use procedures traditionally associated with the judicial process. On the other hand, when government action does not constitute an adjudication, such as when a general fact-finding investigation is being conducted, it is not necessary to use the full panoply of judicial procedures.
(Hannah
v.
Larche, supra,
The full range of procedural due process rights that Smith urges us to require would impose great fiscal and administrative burdens on this process. “[T]he investigative process could be completely disrupted if investigative hearings were transformed into trial-like proceedings .... Fact-finding agencies without any power to adjudicate would be diverted from their legitimate duties and would be plagued by the injection of collateral issues that would make the investigation interminable. . . . This type of proceeding would make a shambles of the investigation and stifle the agency in its gathering of facts.”
(Hannah
v.
Larche, supra,
363 U.S. at pp. 443-444, fn. omitted [
*329 Balancing Smith’s private interests against the Board’s interests, we are satisfied that the state constitutional due process clause does not require the imposition of the full range of due process rights at a reasonablе cause proceeding conducted pursuant to section 2292.
V. Findings
Finally, Smith claims that the administrative process was fatally flawed because the Board did not make findings to support its order. 5 The soundness of this claim depends on the validity of Smith’s due process contention, which we reject. (See part IV, ante.) As such, this contention is also meritless.
The judgment is affirmed.
Anderson, P. J., and Poché, J., concurred.
A petition for a rehearing was denied July 15, 1988, and appellant’s petition for review by the Supreme Court was denied September 15, 1988.
Notes
All statutory references are to the Business and Professions Code, unless otherwise indiсated.
The Board of Medical Quality Assurance is a state agency within the Department of Consumer Affairs. (§ 2001.) It is composed of several divisions, including the Division of Medical Quality. (§ 2003.) This division is responsible for reviewing the quality of medical practice carried out by physicians licensed in this state, carrying out disciplinary actions appropriate to medical quality review findings, and enforcing the disciplinary provisions of the Medical Practice Act. (§ 2004, subds. (a), (c), (e); see §§ 2000-2515 [Medical Practice Act].)
According to the legislative history, the Senate Committee on Health and Welfare rejected a proposal requiring the Board to take action against a physician who fails the examination. (See § 2293, subd. (c) [Board may take action].)
The term “unprofessional conduct" is sufficiently specific when applied to a particular occupation and given context by reference to fitness for the performance of that vocation.
(Cranston
v.
City of Richmond
(1985)
For the first time in his closing brief, Smith suggests that the examination violates his constitutional right to privacy, that section 2292 may be void for vagueness, and that the Board may use section 2292 rather than filing.a formal accusation in order to avoid the procedural due process requirements that attach to such a formal proceeding. As it is unfair for an appellant to raise issues for the first time on appeal in a reply brief, we will not address them. (See
Sunseri
v.
Camperos Del Valle Stables, Inc.
(1986)
In light of our conclusion on the merits, we need not consider Smith’s final contention that he is entitled to reasonable attorney fees for contesting an unconstitutional statute.
